Outcomes of Digital Training for Community Health Workers in Low- and Middle-Income Countries: Scoping Review.

Abstract

Community health workers (CHWs) play an important role in delivering essential health services in low- and middle-income countries (LMICs). Training CHWs using digital approaches is on the rise. Although scoping and systematic reviews of digital training have been conducted for medical professionals in high-income countries (HICs), none have been conducted with lay professionals in LMICs, a population with different considerations. This review describes the characteristics of digital training for CHWs and identifies their impact on health services outcomes in LMICs. A scoping review approach based on Arksey and O'Malley's guiding principles was used to retrieve, review, and analyze existing literature. We searched 10 foremost databases using keywords and Medical Subject Headings terms for CHWs, LMICs, and digital learning to identify primary, peer-reviewed studies published up to and including November 26, 2024. An updated search of studies in all the databases was conducted on January 12, 2026, by the research team. No registries were searched. Articles that focused on the provision of digital or blended learning training for CHWs working in LMICs in any disease domain evaluating a learning, implementation, or clinical outcome met the eligibility criteria. Two reviewers (TAT and FA) screened the articles at the title and abstract levels and at full-text review. Study details, study designs, training attributes, technology and CHW descriptions, and outcomes were abstracted using a data-charting form. Descriptive analysis was conducted of the population, training characteristics, and reported outcomes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting scoping reviews were used. A total of 892 articles were retrieved and screened for eligibility, of which 18 original articles met the inclusion criteria. Most (n=13) were conducted in Asia. Most (n=15) used nonrandomized study designs. The most common attributes included synchronous (n=8), accessible in the community (n=14), use of smartphones (n=6), and accessible online (n=9). The majority reported learning outcomes (n=14), about half reported implementation outcomes (n=10), and only one reported clinical outcomes (n=1). The learning outcomes focused on knowledge gained and were mostly positive. The implementation outcomes included CHW's acceptability and feasibility to use the digital training approach. The clinical outcome was effectiveness. We found few evaluations of digital training for CHWs in LMICs, in spite of a proliferation of such trainings. Digital trainings had a broad range of attributes. Many evaluations had knowledge, acceptability, and feasibility outcomes. However, other learning outcomes (eg, attitudes and skills), implementation outcomes (eg, appropriateness and fidelity), and clinical outcomes were rare. Most lacked experimental designs. Although the existing evidence suggests that digital training can impact knowledge in lay health workers in LMICs, more rigorous studies with a broader range of outcomes are needed.